Name of Team Captain (or individual if entering Individual Division):
Address:
City:
State:
Phone:
E-mail:
Zip:
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Division:
PUZZLE PALOOZA
Saturday, November 9, 2024
Jigsaw Puzzle Tournament
8:00 a.m.- 10:00 a.m. Individuals
10:00 a.m. - 12:00 p.m. Partners
12:00 p.m. - 2:00 p.m. 3 Person Teams
2:00 p.m. - 4:00 p.m. 4 Person Teams - 500 piece
4:00 p.m. - 6:00 p.m. 4 Person Teams - 1000 piece
Location: Shelby Senior Services
2120 Intelliplex Dr.
(YMCA Building)
Shelbyville, IN 46176
Mail Registrations To: Energy2Action, LLC, 1223 Oak Lane, Shelbyville, IN 46176
REGISTER EARLY - SPACE IS LIMITED
Mail in Registrations Must be Received by November 1, 2024
In consideration of the foregoing, I, for myself, my heirs, executors and administrators, waive and release any and all rights and claims for any claims damages I may have against any of the sponsors, volunteers, organizers, City of Shelbyville, The Intelliplex Park, Energy2Action, LLC, YMCA, and Shelby Senior Services, for any and all claims of damages, demands or loss actions whatsoever which may arise as a result of my participation in this event. I understand and acknowledge that participating in this event may expose me to dangers from both known and anticipated risks. I attest and verify that I am physically fit and my physical condition has been verified by a licensed medical doctor. I understand that this event may be canceled or delayed for any legitimate purpose or reason and that my entry fee will not be refunded under those circumstances or for any other reason. Further, I grant full permission to any and all of the foregoing to use my likeness for any legitimate purpose whatsoever.
TEAM NAME:
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SIGNATURE
